Help with erectile dysfunction
December 6, 2010 2:12 PM Subscribe
My partner (I'm female, he's male), has difficulty maintaining an erection during intercourse. He has gone to a urologist and was given a prescription for 100 mg of Viagra, which did not cure the situation. He has ADHD and depression and takes Adderall and an antidepressant.
His physician says that the medications for previously mentioned conditions are meant to calm the brain, but the side effect is that they also calm the penis. However, he has no difficulty maintaining an erection during oral sex. Perhaps this is due to the fact that we don't use condoms during oral sex, thus the contact is closer and there is no interruption in activity for the application of a condom. He also has a curved penis (Peyronnie's disease), and I'm wondering if the curvature could be impacting intercourse...
What to do? He is thinking of abruptly stopping the Cymbalta, as he suspects this is the culprit. Given his depression, I think that's a terrible idea. Plus, he has tried many different medications for his depression and he says this one has helped him. We have not been together long, about 2 months, and this has been an issue since the beginning (just adding that for background). Any suggestions?
His physician says that the medications for previously mentioned conditions are meant to calm the brain, but the side effect is that they also calm the penis. However, he has no difficulty maintaining an erection during oral sex. Perhaps this is due to the fact that we don't use condoms during oral sex, thus the contact is closer and there is no interruption in activity for the application of a condom. He also has a curved penis (Peyronnie's disease), and I'm wondering if the curvature could be impacting intercourse...
What to do? He is thinking of abruptly stopping the Cymbalta, as he suspects this is the culprit. Given his depression, I think that's a terrible idea. Plus, he has tried many different medications for his depression and he says this one has helped him. We have not been together long, about 2 months, and this has been an issue since the beginning (just adding that for background). Any suggestions?
If oral sex is ok, the condom may be the problem not only because of the hiatus when putting it on but also because it is restricting somewhat the blood flow to the penis.
posted by londongeezer at 2:18 PM on December 6, 2010
posted by londongeezer at 2:18 PM on December 6, 2010
I've been on Cymbalta for 2 years now and I DEFINITELY do not recommend he quit cold turkey. The withdrawal symptoms are brutal - "brain zaps" which feel like your brain is going to dry heave, nausea, dizziness, irritability, etc., etc. Taper off slooowwwlly - go to cymbaltawithdrawal.com to read up on this because quitting this drug is no joke. That being said, I have recently started tapering off (I count out individual granules in each capsule) and have found my sex drive returning. Also, I dated a guy who was on Adderall and Zoloft and he had similar dick issues. In my case I think it was a combination of both medications that caused the problems and that may be the case here as well.
posted by tatiana wishbone at 2:24 PM on December 6, 2010
posted by tatiana wishbone at 2:24 PM on December 6, 2010
Is it a crazy idea to just wait another month, both get tested for STDs, start taking oral birth control, and stop using condoms? I'm assuming you're monogamous, and the 3-month guideline is one I've heard tossed around.
posted by pammeke at 2:25 PM on December 6, 2010
posted by pammeke at 2:25 PM on December 6, 2010
Do not abruptly stop the Cymbalta. The discontinuation effects can be nightmarish.
YMMV, but I was on Cymbalta for a few years, and every side effect I experienced subsided after a couple months. The same might happen to him.
Is he seeing a psychiatrist for his antidepressants/ADD meds or just a GP?
posted by Metroid Baby at 2:32 PM on December 6, 2010
YMMV, but I was on Cymbalta for a few years, and every side effect I experienced subsided after a couple months. The same might happen to him.
Is he seeing a psychiatrist for his antidepressants/ADD meds or just a GP?
posted by Metroid Baby at 2:32 PM on December 6, 2010
Response by poster: The oral birth control is an idea, that's assuming that condoms are the main issue here. However, I've been on the pill before and have found the side effects to be intolerable. Plus, the pill is not without risk, and I'd prefer to keep using condoms.
posted by Sal and Richard at 2:32 PM on December 6, 2010
posted by Sal and Richard at 2:32 PM on December 6, 2010
Response by poster: Metroid Baby - he is seeing a psychiatrist for the antidepressant and ADD meds.
posted by Sal and Richard at 2:34 PM on December 6, 2010
posted by Sal and Richard at 2:34 PM on December 6, 2010
Some guys just don't do well with condoms. I can totally understand him having problems with them.
posted by eas98 at 2:35 PM on December 6, 2010
posted by eas98 at 2:35 PM on December 6, 2010
There are other options besides condoms or hormonal birth control, of course.
One thing I see missing here is how sexually experienced you two are. My partner had a heckuva time maintaining an erection while wearing a condom, and he wasn't on any drugs at all. We struggled for about 6 months before we stopped using a condom, and the difference has been amazing.
posted by muddgirl at 2:35 PM on December 6, 2010
One thing I see missing here is how sexually experienced you two are. My partner had a heckuva time maintaining an erection while wearing a condom, and he wasn't on any drugs at all. We struggled for about 6 months before we stopped using a condom, and the difference has been amazing.
posted by muddgirl at 2:35 PM on December 6, 2010
Peyronie's Disease plus condoms can be complicated, but if you guys want to keep using the condoms, why not try using them for oral sex and manual play so that he gets more acclimated to them as part of sexytime?
Maybe more familiarity will make it easier for him to function with the condom?
posted by Sidhedevil at 2:39 PM on December 6, 2010
Maybe more familiarity will make it easier for him to function with the condom?
posted by Sidhedevil at 2:39 PM on December 6, 2010
Oops, I got distracted before I said that IANAD, but I wouldn't be surprised if it was a combination of factors: sure, stopping his meds (which should be done under the supervision of a doctor!) would probably help the whole erection thing. So would getting acclimated to wearing a condom. So would stopping use of a condom.
In my limited experience, it's natural for him to get frustrated with his medication, but please encourage him to speak with a doctor before he stops taking it!
posted by muddgirl at 2:42 PM on December 6, 2010
In my limited experience, it's natural for him to get frustrated with his medication, but please encourage him to speak with a doctor before he stops taking it!
posted by muddgirl at 2:42 PM on December 6, 2010
Everyone is different, but Cymbalta has made my sex drive go through the roof (and it wasn't exactly weak to begin with...). It definitely takes more time to come, but i want sex all. the. time. and I get erections from like...paper clips.
Plus, if he's getting erections during oral sex, then I feel like the anti-depressant is sort of ruled-out as a root cause.
Could be the condoms...good advice upthread about dealing with that.
Are you sure it isn't something just psychological? Like...was he raised very religiously, or has he had abuse issues or something like that in the past? Way TMI here, but there was a time that, because of certain ingrained beliefs and stuff from my childhood, I had a hard time having intercourse because there was a lot of guilt issues, baggage from previous relationship stuff going on. How open is he about talking about it?
posted by Lutoslawski at 2:57 PM on December 6, 2010
Plus, if he's getting erections during oral sex, then I feel like the anti-depressant is sort of ruled-out as a root cause.
Could be the condoms...good advice upthread about dealing with that.
Are you sure it isn't something just psychological? Like...was he raised very religiously, or has he had abuse issues or something like that in the past? Way TMI here, but there was a time that, because of certain ingrained beliefs and stuff from my childhood, I had a hard time having intercourse because there was a lot of guilt issues, baggage from previous relationship stuff going on. How open is he about talking about it?
posted by Lutoslawski at 2:57 PM on December 6, 2010
Talk to his doctor about adding bupropion to his current medication regimen. It sometimes helps with sexual side effects caused by other antidepressants. Even if he already tried bupropion alone and found it didn't work well as an antidepressant it could be helpful in conjunction with the Cymbalta.
Also, look into using polyurethane condoms. My husband and I both hated latex condoms but had few issues with polyurethane. It's more comfortable and conducts heat and sensation better.
posted by Serene Empress Dork at 3:00 PM on December 6, 2010
Also, look into using polyurethane condoms. My husband and I both hated latex condoms but had few issues with polyurethane. It's more comfortable and conducts heat and sensation better.
posted by Serene Empress Dork at 3:00 PM on December 6, 2010
Best answer: Have you tried different condoms? Polyurethane condoms like the Durex Avanti and Trojan Supra are worlds better than your standard latex jobs.
posted by mkultra at 3:03 PM on December 6, 2010
posted by mkultra at 3:03 PM on December 6, 2010
I had a similar issue. In my case, it was Zoloft. When that was the only medication I took, I liked the extra control and staying power it allowed me to have. And, you know, not being depressed.
When I added in ADHD medication, it started out OK. But after a while, I began to notice the same symptoms. It wasn't that I couldn't get erections or that I lacked desire. It was simply that my desire "ran out" before the bedroom activity had run its natural course to an acceptable completion for both parties. I wanted to be horny, but it just wasn't there.
At the same time, I noticed myself feeling stressier and stressier. Not sleeping well. Work was stressful, but no more or less than I had previously been able to handle.
I started to figure something weird was happening when I decided to skip a day of the ADHD medication (Vyvanse in this case). Instead of the expected and usual day of napping, I was kind of wired. Absolutely exhausted, but the brain was spinning and couldn't sleep. Etc.
I did some research. Turns out that zoloft is an antagonist for the liver enzyme that breaks down amphetamine. (As is cymbalta, btw.) What was happening was that over the course of months, my blood level of amphetamine was slowly increasing. My metabolism of it was just slowed down enough that there was a tiny little bit left over every day when I took the next pill. So in effect, I was upping my dose by a tiny bit every day.
Switched from Zoloft to Wellbutrin and it all went away in fairly short order. Brain zaps were unpleasant, but tolerable. You just need to taper the right way (doctor approved, of course) and understand that you'll have the zaps as well as a bit of moodiness. Remembering that it is just a chemical reaction and not "real" helps a lot.
posted by gjc at 3:06 PM on December 6, 2010
When I added in ADHD medication, it started out OK. But after a while, I began to notice the same symptoms. It wasn't that I couldn't get erections or that I lacked desire. It was simply that my desire "ran out" before the bedroom activity had run its natural course to an acceptable completion for both parties. I wanted to be horny, but it just wasn't there.
At the same time, I noticed myself feeling stressier and stressier. Not sleeping well. Work was stressful, but no more or less than I had previously been able to handle.
I started to figure something weird was happening when I decided to skip a day of the ADHD medication (Vyvanse in this case). Instead of the expected and usual day of napping, I was kind of wired. Absolutely exhausted, but the brain was spinning and couldn't sleep. Etc.
I did some research. Turns out that zoloft is an antagonist for the liver enzyme that breaks down amphetamine. (As is cymbalta, btw.) What was happening was that over the course of months, my blood level of amphetamine was slowly increasing. My metabolism of it was just slowed down enough that there was a tiny little bit left over every day when I took the next pill. So in effect, I was upping my dose by a tiny bit every day.
Switched from Zoloft to Wellbutrin and it all went away in fairly short order. Brain zaps were unpleasant, but tolerable. You just need to taper the right way (doctor approved, of course) and understand that you'll have the zaps as well as a bit of moodiness. Remembering that it is just a chemical reaction and not "real" helps a lot.
posted by gjc at 3:06 PM on December 6, 2010
I'll just add (because nobody's mentioned it yet) that ED is a very, very common side effect of Adderall.
posted by General Malaise at 3:09 PM on December 6, 2010
posted by General Malaise at 3:09 PM on December 6, 2010
Dick trouble's tricky 'cause sometimes it's mental and sometimes it's physical and sometimes it's both and sometimes it's one caused or exacerbated by the other.
If he's got depression and other issues, and he's on medication that is helping him, he should stay on it. Even if it's causing some bedroom problems for the two of you.
Also, are YOU getting what you need sexually? Is that the issue behind your question?
Here are a couple of ideas. You say he performs normally with condomless oral. (I hope he's giving as good as he's getting, fair is fair.) How about when you use your hands?
Does everything still work well that way, without a condom, maybe some lube or lotion? Can you orgasm by him using his hands on you, or adding a vibrator? You can have pretty hot face-to-face 'manual' sex and everybody gets off and no one ends up feeling inadequate or unsatisfied, and everybody's safe. If he's had lifelong mental health issues and possibly spent a lot of time alone, part of the problem might be with the intimacy of face to face sexual stimulation. This might be a way to work up to that and get more comfortable with it.
It might also (with some practice?) be a way to sneak a condom in there and transition to penetration. If it's the case that he's spent a lot of time partnerless and masturbating, part of the performance problem might be that condoms are an unfamiliar, maybe unpleasant alien feeling. If you can get each other all worked up using your hands, it should only take a little practice to quickly introduce a condom and move into the next gear without a break in the action and blowing the mood.
That's another thing about condoms and performance. The act of stopping, changing everything, then doing this somewhat embarrasing and uncomfortable thing can really make a guy lose...the moment. Imagine it the other way around, how likely is it that you'd lose some of your mojo if you had to pause and go get your diaphragm and some spermicidal jelly and put it in while he watched impatiently? Or even worse, one of those female condoms so after that interruption you couldn't even feel yourself as much as that nasty balloon/plastic wrap feeling (god they're awful)?
I'm not anti-condom or advising unsafe sex, but it's more than 'holding hands while wearing dishwashing gloves'. It's like anticipating a fine meal and having the appetizers, but when the waiter arrives you have to put on a magic clown mask that loses your sense of smell and gives everything the texture of oatmeal - and your dinner companion doesn't. Especially if he's not been very sexually active because of his other issues and may have anxieties already, performing under those conditions, and liking it, is something that has to be worked up to.
posted by bartleby at 3:16 PM on December 6, 2010 [1 favorite]
If he's got depression and other issues, and he's on medication that is helping him, he should stay on it. Even if it's causing some bedroom problems for the two of you.
Also, are YOU getting what you need sexually? Is that the issue behind your question?
Here are a couple of ideas. You say he performs normally with condomless oral. (I hope he's giving as good as he's getting, fair is fair.) How about when you use your hands?
Does everything still work well that way, without a condom, maybe some lube or lotion? Can you orgasm by him using his hands on you, or adding a vibrator? You can have pretty hot face-to-face 'manual' sex and everybody gets off and no one ends up feeling inadequate or unsatisfied, and everybody's safe. If he's had lifelong mental health issues and possibly spent a lot of time alone, part of the problem might be with the intimacy of face to face sexual stimulation. This might be a way to work up to that and get more comfortable with it.
It might also (with some practice?) be a way to sneak a condom in there and transition to penetration. If it's the case that he's spent a lot of time partnerless and masturbating, part of the performance problem might be that condoms are an unfamiliar, maybe unpleasant alien feeling. If you can get each other all worked up using your hands, it should only take a little practice to quickly introduce a condom and move into the next gear without a break in the action and blowing the mood.
That's another thing about condoms and performance. The act of stopping, changing everything, then doing this somewhat embarrasing and uncomfortable thing can really make a guy lose...the moment. Imagine it the other way around, how likely is it that you'd lose some of your mojo if you had to pause and go get your diaphragm and some spermicidal jelly and put it in while he watched impatiently? Or even worse, one of those female condoms so after that interruption you couldn't even feel yourself as much as that nasty balloon/plastic wrap feeling (god they're awful)?
I'm not anti-condom or advising unsafe sex, but it's more than 'holding hands while wearing dishwashing gloves'. It's like anticipating a fine meal and having the appetizers, but when the waiter arrives you have to put on a magic clown mask that loses your sense of smell and gives everything the texture of oatmeal - and your dinner companion doesn't. Especially if he's not been very sexually active because of his other issues and may have anxieties already, performing under those conditions, and liking it, is something that has to be worked up to.
posted by bartleby at 3:16 PM on December 6, 2010 [1 favorite]
Let's see if I can channel Dan Savage here...
This may just be a case of the dreaded Death Grip. Men sometimes masturbate with a tightly clenched fist, and this can really desensitize the penis. The subtle sensation of sex with a condom will hardly even register. Add to this a self-fulfilling case of performance anxiety, and it can really be a bummer. The Cymbalta may be contributing too, but it sounds like he really needs that, so it's probably best to address other factors first.
The prescription:
1. Masturbate gently, or stop cold turkey for a while.
2. Lower expectations, and don't act all disappointed when things get soft. Just laugh it off and switch gears to one of the many sex activities that don't require an erection.
3. Explore non-hormonal, non-condom birth control options.
posted by qxntpqbbbqxl at 3:17 PM on December 6, 2010
This may just be a case of the dreaded Death Grip. Men sometimes masturbate with a tightly clenched fist, and this can really desensitize the penis. The subtle sensation of sex with a condom will hardly even register. Add to this a self-fulfilling case of performance anxiety, and it can really be a bummer. The Cymbalta may be contributing too, but it sounds like he really needs that, so it's probably best to address other factors first.
The prescription:
1. Masturbate gently, or stop cold turkey for a while.
2. Lower expectations, and don't act all disappointed when things get soft. Just laugh it off and switch gears to one of the many sex activities that don't require an erection.
3. Explore non-hormonal, non-condom birth control options.
posted by qxntpqbbbqxl at 3:17 PM on December 6, 2010
Response by poster: Hmm, polyurethane condoms. Thanks for that suggestion! Hadn't thought about that.
LMAO at qxntpqbbbqxl's death grip theory. I will pass that one along to him!
posted by Sal and Richard at 3:30 PM on December 6, 2010
LMAO at qxntpqbbbqxl's death grip theory. I will pass that one along to him!
posted by Sal and Richard at 3:30 PM on December 6, 2010
Try female condoms?
I found side effects of every single birth control pill intolerable, but love the nuvaring. I have at least three girlfriends who feel the same way.
posted by namesarehard at 4:20 PM on December 6, 2010
I found side effects of every single birth control pill intolerable, but love the nuvaring. I have at least three girlfriends who feel the same way.
posted by namesarehard at 4:20 PM on December 6, 2010
Seriously, have him look at that book I mentioned. The moment it goes down this route, even if the physical problem is ameliorated, its not enough. The book has exercises he can do and you can do together as well as a lot of background which is very important to getting a grip on male sexuality and feeling good about himself in this context.
posted by blueyellow at 4:44 PM on December 6, 2010
posted by blueyellow at 4:44 PM on December 6, 2010
polyurethane condoms transmit heat better than latex, but I've broken more of them than latex ones. For latex, Kimono microthins weren't too bad.
Currently, we're using an IUD which is working out very well.
posted by plinth at 5:33 PM on December 6, 2010
Currently, we're using an IUD which is working out very well.
posted by plinth at 5:33 PM on December 6, 2010
if you're std free diaphragms, while old fashioned, are AMAZING if applied properly! booo hormonal birth control.
posted by 2003girl at 5:41 PM on December 6, 2010
posted by 2003girl at 5:41 PM on December 6, 2010
If the pill is a problem, you can also try the patch -- it works quite well for my fiancée.
posted by TheyCallItPeace at 5:49 PM on December 6, 2010
posted by TheyCallItPeace at 5:49 PM on December 6, 2010
He could either add Welbutrin to his drug regimen to counteract the Cymbalta, which is a so-so remedy (it would help with maintaining his erection, but he'd still be on Cymbalta, which has other problems, like nausea and dizziness increasing over time), or taper off the Cymbalta and try another anti-depressant, like Pristiq maybe.
Everyone has different needs and tolerances and IANhisD, of course, but I've been on a number of anti-depressants over the years, and I can tell you both that Pristiq rocks for me and that Cymbalta is the only one that gave me serious withdrawal symptoms, so please please please do NOT let him just quit his medication! If he chooses to go off Cymbalta, he has to do it slowly.
And that's the course I'd really recommend, because the more time spent on Cymbalta, the worse the withdrawal will be once he goes off of it. I really wish doctors wouldn't be so quick to prescribe that drug; I'd want anyone I care about to stay far away from it.
posted by misha at 9:49 PM on December 6, 2010
Everyone has different needs and tolerances and IANhisD, of course, but I've been on a number of anti-depressants over the years, and I can tell you both that Pristiq rocks for me and that Cymbalta is the only one that gave me serious withdrawal symptoms, so please please please do NOT let him just quit his medication! If he chooses to go off Cymbalta, he has to do it slowly.
And that's the course I'd really recommend, because the more time spent on Cymbalta, the worse the withdrawal will be once he goes off of it. I really wish doctors wouldn't be so quick to prescribe that drug; I'd want anyone I care about to stay far away from it.
posted by misha at 9:49 PM on December 6, 2010
Adding Wellbutrin helped partners of mine.
And though I agree that while perhaps slowly getting of Cymbalta is the right answer eventually, do this under doctor supervision and S-L-O-W-L-Y. Trust me -- while quitting it quickly might help him be able to perform better, speaking from experience, it could very easily make him someone you have no interest in having sex with (and quite probably make him not very interested in to). So be careful. Which seems obvious. But the reason why I can say this from experience is that it doesn't always.
posted by MCMikeNamara at 7:14 PM on December 8, 2010
And though I agree that while perhaps slowly getting of Cymbalta is the right answer eventually, do this under doctor supervision and S-L-O-W-L-Y. Trust me -- while quitting it quickly might help him be able to perform better, speaking from experience, it could very easily make him someone you have no interest in having sex with (and quite probably make him not very interested in to). So be careful. Which seems obvious. But the reason why I can say this from experience is that it doesn't always.
posted by MCMikeNamara at 7:14 PM on December 8, 2010
This thread is closed to new comments.
My husband had the same problems on an antidepressant, and it's been a year now, he's finally tapering off, and sexy times are back to normal.
posted by lollusc at 2:16 PM on December 6, 2010